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Medical Ethics in Prisons: Rules, Standards and Challenges
International Journal of Prisoner Health Volume:2 Issue:4 Dated:December 2006 Pages:259 to 267
This article discusses the importance and applications of traditional medical ethics in the health care of inmates under the distinctive conditions of a custodial setting. It is not only important that prison physicians and health care workers as individuals comply with medical ethics, but also that medical ethics are made known to and accepted by the inmates and the prison administration. Numerous ethical dilemmas are encountered in prison health care. The principles of privacy, confidentiality, and consent, which are fundamental in medical care, conflict with principles of custodial care, namely, that security and safety come first. Also, access to and quality of medical care may be compromised by the lack of resources and overcrowding. Further, the professional independence of the prison doctor, who is employed and salaried by the prison administration, may lose the decisionmaking power customary in health care. Although ethical dilemmas in inmate health care must be solved on a case-by-case basis, accepted international rules and standards on medical ethics can guide prison doctors and prison staff through many of these dilemmas. The essential ethical principles for inmate health care are contained in the document developed by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment 2004. It mandates free access to a doctor for every prisoner, inmate health care equivalent to that given to the general public, patient consent and confidentiality, preventive health care, humanitarian assistance, professional independence, and professional competence. Compliance with these principles promotes inmates' confidence in the medical care they receive, leaves no doubt as to the doctor's medical professionalism and ethics, prevents misunderstandings, provides guidance in ethical conflict, supports quality assurance in medical work, and protects against law suits. 11 references and a list of United Nations documents that pertain to inmate health care
From Equivalence of Standards to Equivalence of Objectives: The Entitlement of Prisoners to Health Care Standards Higher Than Those Outside Prisons
International Journal of Prisoner Health Volume:2 Issue:4 Dated:December 2006 Pages:269 to 280
This article argues that human rights obligations and public health needs require that inmates, who typically have a prevalence of serious health problems beyond those of the average citizen, will require health services that surpass those received by the average citizen. It is generally accepted that individuals in prison have a right to a standard of health care that is equivalent to that provided people outside prison. Given the extreme health problems evident among prisoners worldwide, however, along with the threat they pose to public health in general, inmates should receive a higher level of care in order to achieve the same health outcome as the average person outside prison. As one example, within prisons, the risk of the spread of tuberculosis (TB) is heightened by infectious and overcrowded prison conditions. Inadequate medical infrastructure or inconsistent access to medications heightens the risk of developing multidrug resistant strains of TB within prison populations. TB is only one example of health problems that are magnified within the prison environment. According to the World Health Organization, prisons are places where "two of the greatest public health problems facing all societies overlap: the epidemic of HIV/AIDS and the pandemic harmful use of psychotropic substances such as alcohol and illegal drugs." Changing the measure of inmate health care from equivalent standards of health care to standards that achieve equivalent objectives requires that health care rise to the level of addressing prison conditions that promote disease and inhibit the provision of effective treatment of the serious diseases prevalent in prisons. 49 references and appended legislation recommended for Ireland that will preserve the health of prisoners in "gaol" (jail or prison) and prevent "gaol distemper"
Jilla Burgess-Allen; Michele Langlois; Paula Whittaker
Health Needs of Ex-Prisoners, Implications for Successful Resettlement: A Qualitative Study
International Journal of Prisoner Health Volume:2 Issue:4 Dated:December 2006 Pages:291 to 301
This qualitative study identified the health needs of 27 ex-prisoners living in an urban borough in Northwest England. The majority of the ex-prisoners interviewed had mental disorders and substance abuse problems; however, most did not seek mental health services, and they were generally unclear about how their substance abuse was affecting their physical health. The 14 service providers interviewed were more aware of and concerned about the health needs of the ex-prisoners than were the ex-prisoners themselves. When the ex-prisoners and service providers were questioned about how the reentry process and ex-prisoner health could be improved, most of the recommendations were offered by the service providers. Among the recommendations for improving ex-prisoners' health care were to have better communication between prison health care providers and community health care agencies, to improve cooperation between mental health services and drug treatment services, and to develop a single health record for young offenders that would be transferred from prison to appropriate community agencies. Housing for ex-prisoners was identified by both service providers and ex-prisoners as a significant issue that affects ex-prisoner health. Homelessness and associated distress should be addressed by improved planning for housing prior to release, followed by the monitoring of ex-prisoner housing issues after their release. The provision of hostels for ex-prisoners with drug/alcohol problems was considered ideal. The study consisted of interviews with 27 ex-prisoners and 14 of the service providers who worked with them. They were asked about the reentry experience and how it impacted ex-prisoners' health, the broad health concerns of ex-prisoners, and how these could be better addressed. 1 table and 13 references